Psychometric Testing of the Hebrew Version of the European Heart Failure Self-Care Behaviour Scale

Tuvia Ben Gal, Naoko P. Kato, Vicky Yaari, Ben Avraham, Leonie Klompstra, Anna Strömberg, Tiny Jaarsma

Research output: Contribution to journalArticlepeer-review


Background: The assessment of self-care behaviour is important for tailoring care to patients and evaluating the effectiveness of heart failure (HF) disease-management programmes. The European HF Self-care Behaviour (EHFScB) scale is a validated instrument used worldwide. Aim: The purpose of the study was to evaluate psychometric properties of the Hebrew version of the nine-item EHFScB scale in Israeli patients with HF. Method: To develop the Hebrew version of the EHFScB scale, forward and back translation was performed. The psychometric evaluation was based on data from 102 patients with HF (mean age 61±12 yr, male 75%, New York Heart Association [NYHA] class II 42% and NYHA class III 51%) included in two cross-sectional studies performed in 2007 and 2015-2017 in an Israeli hospital. Content validity, construct validity, known-groups validity, and discriminant validity were assessed. Reliability was evaluated with internal consistency. Results: Content validity and useability were confirmed by HF experts and patients with HF. Construct validity was tested using factor analysis and two factors were extracted (factor 1: consulting behaviour; factor 2: adherence to the regimen). Known-groups validity testing revealed a significant difference before and after an educational intervention in the total score (n=40 [41.6±23.8] vs [67.6±21.8]; p<0.01). A weak correlation between the self-care score and health-related quality of life (r= –0.299, p<0.01) was observed, showing that these concepts were related but not overlapping. Cronbach's alpha was 0.78 for the total scale, 0.76 for factor 1, and 0.68 for factor 2, suggesting that the internal consistency of this scale was acceptable. Conclusions: Our study provides support for the useability, validity, and reliability of the nine-item Hebrew version of the EHFScB scale.

Original languageEnglish
Pages (from-to)e121-e130
JournalHeart Lung and Circulation
Issue number7
StatePublished - Jul 2020


  • Heart failure
  • Measurement
  • Reliability
  • Validity


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